‫نفسية‬ ‫صفية‬.

‫د‬
Lec:10 5/‫موصل‬ ‫عدد االوراق‬
Acute stress disorder
DSM-5 diagnostic criteria for Acute Stress Disorder
Criterion A: Traumatic event
Exposure to
1. actual or threatened death
2. serious injury
3. sexual violation

in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or
close friend.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic
event(s)

Directly experienced traumatic events

1. Exposure to war (combatant, civilian)
2. Threatened or actual physical assault
3. Threatened or actual sexual violence
4. Being kidnapped
5. Being taken hostage
6. Terrorist attack
7. torture
8. Incarceration as prisoner of war
9. Natural or human-made disasters
10. Severe motor vehicle accident

Directly experienced traumatic events

Threatened or actual physical assault
i) Physical attack
ii) robbery
iii) mugging
iv) Childhood physical abuse

1|Page
Directly experienced traumatic events
Threatened or actual sexual violence
1. Forced sexual penetration
2. Alcohol/drug facilitated sexual penetration
3. Abusive sexual contact
4. Noncontact sexual abuse
5. Sexual trafficking
6. Developmentally inappropriate sexual experiences

Medical incidents that qualify as traumatic events

Sudden catastrophic events
1. Waking during sugary
2. Anaphylactic shock

Witnessed events
1. Observing threatened or serious injury
2. Unnatural death
3. Physical or sexual abuse of another person due to violent assault
4. Domestic violence
5. Accident
6. War or disaster
7. Medical catastrophe in one’s child

Indirect exposure
Violent or accidental experiences affecting close relatives or friends
1. Violent personal assault
2. suicide
3. Serious accident
4. Serious injury
Criterion B: Intrusion
recurrent, involuntary, and intrusive distressing
1. memories
2. dreams
3. dissociative reactions
4. Psychological distress & Physiological reaction*
*At exposure to internal or external cues that symbolize or resemble an aspect
of traumatic event.

2|Page
Criterion C: Negative mood
Persistent inability to experience positive emotions (e.g., inability to experience
happiness, satisfaction, or loving feelings).

Criterion D: Dissociative Symptoms

• An altered sense of the reality of one’s surroundings or oneself (e.g.,
seeing oneself from another’s perspective, being in a daze, time slowing).
• Inability to remember an important aspect of the traumatic event(s)
(typically due to dissociative amnesia and not to other factors such as head
injury, alcohol, or drugs).

Criterion E: Avoidance Symptoms

 Efforts to avoid distressing memories, thoughts, or feelings about or closely
associated with the traumatic event(s).
 Efforts to avoid external reminders (people, places, conversations, activities,
objects, situations) that arouse distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).

Criterion F: Arousal Symptoms

1. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
2. Irritable behavior and angry outbursts (with little or no provocation), typically
expressed as verbal or physical aggression toward people or objects.
3. Hypervigilance.
4. Problems with concentration.
5. Exaggerated startle response.

Criterion G: duration
• Duration of disturbance
3 days1 month

Criterion H:Functional significance

The disturbance causes clinically significant distress or impairment in 
1. social
2. occupational
3. other important areas of functioning

3|Page
Criterion I
The disturbance is not attributable to the physiological effects of a substance or
another medical condition

Aetiology
1. Pretraumatic factors
2. Peritraumatic factors
3. Posttraumatic factors

1) Aetiology
a) Pretraumatic factors
i) Childhood emotional problem
ii) Prior mental disorder

b) Peritraumatic factors
i) Severity of trauma
ii) Perceived life threat
iii) Personal injury
iv) Interpersonal violence
v) Military personnel
vi) Being a perpetrator
vii) Witnessing atrocities
viii) Killing the enemy

c) Posttraumatic factors
i) Negative appraisal
ii) Inappropriate coping
iii) Development of acute stress disorder
iv) Exposure to repeated reminder
v) Subsequent adverse life events
vi) Financial lose

Management of ASD
Psych therapy
o Cognitive-Behavioral Therapy
 trauma-focused CBT is an effective treatment

4|Page
Cognitive-Behavioral Therapy
a) psychoeducation
b) anxiety management
i) breathing retraining
ii) relaxation skills
iii) self-talk
c) exposure
i) imaginal
ii) in vivo exposure
d) cognitive restructuring

Pharmacotherapy
1. escitalopram
2. TCA
3. temazepam
4. propranolol
5. cortisol
6. morphine

Reactions to stressful experiences

The response to stressful events
1. An emotional response, with somatic accompaniments.
2. A coping strategy.
3. A defence mechanism.

Emotional and somatic responses

1. Anxiety responses
i) threat
2. Depressive responses
i) separation or loss

Coping strategies
1. problem-solving strategies,
i) make adverse circumstances less stressful;
2. emotion-reducing
3. strategies
i) alleviate the emotional response to the stressors.

5|Page
The response to stressful events
a) An emotional response, with somatic accompaniments.
i) Anxiety responses
(1) threat
ii) Depressive responses
(1) separation or loss
b) A coping strategy.
i) problem-solving strategies,
(1) make adverse circumstances less stressful; strategies,
ii) emotion-reducing strategies
(1) alleviate the emotional response to the stressors.
c) A defence mechanism.

Problem-solving strategies
a) Obtaining information or advice
b) Solving problems
c) Confrontation

Emotion-reducing strategies
1. Ventilation of emotion
2. Evaluation of the problem
3. Positive reappraisal of the problem
4. Avoidance of the problem

Maladaptive coping strategies

These strategies reduce the emotional response to stressful circumstances in
the short term, but lead to greater difficulties in the long term.

Maladaptive coping strategies

1. Use of alcohol or unprescribed drugs
2. Deliberate self-harm
3. Unrestrained display of feelings
4. Aggressive behaviour

Coping styles
When particular coping mechanisms are used repeatedly by the same person
in different situations

6|Page
Defence mechanisms
1. Repression
2. Denial
3. Displacement
4. Projection
5. Regression
6. Reaction formation
7. Rationalization
8. Sublimation
9. Identification

7|Page